| NPI | 1508486713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: FL APRN11026213) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9468568) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9468568) | |
| 163WP0200X Registered Nurse, Pediatrics (Licence: FL RN9468568) | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP027277) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2023-09-26 |